Tuesday, November 22, 2016

John F. Kennedy

Fifty-three years ago, the United States' thirty-fifth president was assassinated in Dallas, TX.

Intersubjectivity includes the constant struggle to hold the tension between recognizing the other as a subject and the tendency to see the other as an object.  As our country struggles, after a divisive election, to maintain the capacity to see the other as having the equal right to her/his own thoughts and opinions, I am reminded of the college paper of my younger daughter on JFK. She wrote:

In a speech at American University June 10, 1963 Kennedy reached out to the Soviet Union to join with the USA in ceasing to hold the world hostage with nuclear weapons testing.

       History teaches us that enmity between nations as between
       individuals do[es] not last forever. No government or social
       system is so evil that its people must be considered as lacking
       in virtue. Among the many traits that the peoples of our two
       countries have in common, none is stronger than our mutual
       abhorrence of war.

Historian Timothy Naftali said of this commencement speech,

           It’s the first time an American president said ‘the Soviets
           are like us’. It’s the first he asked the American people to
           think beyond stereotypes and the Cold War and think
           about the fact that this is a matter of the future of the
           human race.

Six weeks later, Kennedy reached an agreement with Khrushchev to ban testing on nuclear weapons. Kennedy referred to the negotiation as “a shaft of light cut into the darkness.”

Friday, November 4, 2016

Literature as the Third

Fred Griffin (2005) uses the work of physician and poet William Carlos Williams to “re-establish an imaginative space” when Griffin finds himself at an impasse in clinical work with Mr.D and at a loss for reflective thinking. Griffin describes the use of literature, and words, to create and contain experience, as well as describes his personal account of using literature to stimulate his “imaginative capacities.” In Williams’ short story “The Use of Force,” Griffin finds himself envying, then, through reverie, identifying with the physician protagonist  in the story who has the “freedom to possess an entire range of feeling states and … facility of movement among them…” [Bromberg] for “generative self inquiry” which allows Griffin to reinstate his capacity for thinking (ala Bion).

Certainly there is more to the shared analytic experience than mere words or narrative, and Griffin states his appreciation for wordless communication. He also astutely notes the parallel between analytic work, which may eventually find words for unspeakable experience, and the literary author’s struggle to give words to experience.  He notes that transference-countertransference “is a type of fiction that tells us what the patient’s internal object world is like as it is creating itself.” He quotes Williams:

    Some kind of poetic form has to be found or I’ll go crazy.

Griffin writes of Williams, “...he finds/creates words to articulate this living thing, the experience that is conceived and given life in the room.” Not only can words serve as a holding function, but, without words forming a bridge between experience and experiencer, between experiencer and witness, experience can remain dissociated and devoid of meaning, and the experiencer can feel utterly alone. When there is a loss for words, one is imprisoned.Griffin, too, knows that he and Mr. D must find a way together out of each feeling he is in his own “solitary confinement.” [Recently, a patient of mine, feeling his rage impotent to have an effect on his parents, said to me that he felt trapped in a room alone and screaming. His parents could neither see nor hear him.]

Solitary confinement is a place of desperation and despair transcended by the act of communion when an Other ‘gets’ one’s experience and the ‘getting’ is expressed in words. Williams wrote

  The physician enjoys a wonderful opportunity actually to witness the words being born...which he is privileged to take into his care with their unspoiled newness…[W]e have been the words’ very parents. Nothing is more moving..

In saying we are the parents of words, Williams becomes relational in the co-creation of meaning.

Griffin, FL (2005) Clinical Conversations between Psychoanalysts and Imaginative Literature. Psa Q, 4: 443-463.

Tuesday, October 18, 2016

Insights from Jane Hall, LCSW

            This past Saturday (10/15/16), psychoanalyst and author Jane Hall explored with the Tampa Bay Psychoanalytic Society the concept of “attachment to abuse,” specifically the incredible bind in which many patients abused as children find themselves as adults when seeking to live a freer, more constructive life.  Hall posed both psychological and physiological factors that continue to “haunt” abused children across their lifespan.  Psychologically, these children have internalized within both the abuse and the abuser, coloring how they will experience themselves, others, and themselves in relationship with others. Physiologically, the sustained dis-ease of home life triggers high levels of cortisol, now shown to negatively affect the developing brains of children.  Each of these factors alone, let alone the interactive effect of both together, shape the way in which these individuals think, feel, and behave in the world.  Hall noted that such individuals will respond somewhere on a continuum: from mild self-punishment all the way to psychopathy.  Put more succinctly, the sustained childhood abuse eventually will leave somebody dead. This death may manifest in extreme cases as either suicide or homicide, including acts of terrorism.  Other types of death include the loss of the self (an absence of self-esteem) and the loss of the object (an inability to form intimate relationships).

            Hall postulated that as psychoanalysts, our role is to listen – with benign curiosity, and this type of listening will, over time, enable the early childhood wound to form a scar, and with continued listening, that scar will eventually shrink.   Our consistent frame and benignly curious listening can ultimately allow not only the mind to change as noted above, but, Hall citing recent neurological research, posits that the very brain itself can change because of its inherent neuroplasticity. 

           The challenge for a patient to move from such a wound to a diminishing scar is significant.  Because of the painful parental treatment (e.g., controlling, neglecting, cold), these abused children fashion ways to protect themselves from such harm.  These defenses, however, keep out not only that which is harmful, but that which is necessary and good. As adults, these children are unable to absorb love, though they are desperate for it.  The challenge of treatment is to invite these children-turned-adults to “loosen ties to their original object,” as Hall explained.  This is the only path forward to prevent them from finding ways of repeating their abuse – as abuser/abused or both.  This way of safety and protection learned in childhood has become a character trait that prevents a fulfilling adult life.

            Contrasted with Winnicott’s “good enough mother,” Hall described the “bad enough mother,” who for a host of reasons may not have been able to meet the normal developmental needs of her child. This mother, herself, may have had a “bad enough mother,” passing onto the next generation the familiar and familial trauma.  Hall noted that we as therapists may find ourselves sucked into the role of the bad enough mother and, as a result, dealing with the patient punishing us in a variety of ways.  One of the most effective punishments, she illustrated, is the patient's refusal to get better, thereby torturing the analyst.

            Hall cautioned us that this move from the attachment to abuse to a more secure attachment with the analyst and others in the patient’s life is not easily achieved.  The patient will fight to hold onto that which is familiar while at the same time desperately longing for something healthier.  She suggested that we must find ways to survive the onslaught of the patient’s hopelessness, rage, and helplessness likely with the help of a support system ourselves. Hall concluded the morning presentation with two case studies with patients she had seen in analysis over many years, both of whom have found ways of living meaningful lives after living through significant traumata as children.

Steven D. Graham, PhD, DMin

Friday, October 14, 2016

Dylan wins Nobel Prize

Yesterday, it was announced that Bob Dylan, in keeping with Orpheus and other bards’ tradition of music and poetry, has won the 2016 Nobel Prize for literature, a first for a musician, but not, of course, for poetry. Dylan, born Robert Zimmerman in Minnesota in 1941, who denied he changed his name to Dylan because of another poet, Dylan Thomas, hit the folk scene in NYC in 1961 and became an icon for songs such as “Blowing in the Wind” made famous by the already renowned folk singers Peter, Paul, and Mary. In 1965, Dylan went electric, debuting his new style at the Newport Folk Festival, where the change was not well received by his folk music fans. Dylan also sung country, blues, and gospel, and rock and roll leading music biographer David Hajdu (Positively Forth Street) to say of Dylan, “He contains multitudes.” Dylan himself said, “You are constantly in the state of becoming.” Neuroplasticity agrees.

Dylan, who boasts over 60 albums, was awarded the Prize “for having created new poetic expressions within the great American song tradition.”   An American has not won the Nobel Prize for Literature since 1993 (Toni Morrison). This honor was added to his induction in the Rock and Roll Hall of Fame in 1988, and his Presidential Medal of Freedom in 2012.

Therapists know the necessity of not relying wholly on the narrative, the explicit, the spoken word. Dylan, too, understood something about words, “Words have their own meanings or they have different meanings. And then all words change their meanings.” (Scorsese, 2005, No Direction Home). He influenced countless musicians, James Taylor, Bruce Springsteen, and U2.

A personal note: A fan of his music since I was 8 years old, perhaps Dylan made us feel revolutionary, for even my civil rights demonstrating mother, more of a Bizet fan, upon hearing Bob Dylan on the stereo record player, said, only somewhat disparagingly, “He lows like a cow.”

Tuesday, October 11, 2016

Group Therapy Supervision and Confrontation

I am thankful to the instructor for trying to hold our dialogue in her mind and trying to find an answer to her dilemma. I want to state that I do not feel her comments as a confrontation. Rather, I experience her as passionately arguing her interests in the group which I run. Accordingly, I do not feel that I confront group members, but, rather that I am empathically attuned with patient’s needs to be hateful to the group and to be self-destructive.

Also, within this supervision, we have both chosen to co-create an experiment: the instructor to supervise and I to be supervised for a group by a supervisor who is not a group therapist. This is mutually confronting, I think, also for the class. Unless we have the courage to visit unvisited areas of our experience, therapy, and supervision, cannot take place. I find this experience anxious enough to help my growth and the bouts of shame that may occur as the necessary elements of that. Being humiliated for the badness is not the same thing as being empathically confronted for your need to be bad.

I think that there are many ways that confrontation can occur and it seems that, as a supervisory group, we have started exploring this range. As a supervisee I do not feel shame when you suggest something different. In a parallel process also, I think the group member had the courage to be hateful enough and the group was courageous enough to challenge empathically her destructiveness. The shame that may arise reflects the underlying shame she got when she wanted to attack her family and they did not let her be hateful enough. Now, in the group, she is starting to realize her destructiveness.

I quote a paragraph from a Darlene Ehrenberg paper and also the paper to perhaps assist us:

For some the realization that dealing with difficult feelings and tensions in immediate relation to the another can lead to both learning and growing and the relationship becoming stronger, rather than either or the relationship being threatened or diminished, may be a revelation (Ehrenberg, 1996). This kind of revelation is an “insight” that cannot be conveyed in words. It is the lived experience that that this is possible that is the “insight.” This kind of “insight” is in response to change, which is contrary to the idea that insight is what leads to change. Rather, the lived new experience, in all its profound emotional intensity, in the immediate analytic interaction is what is “mutative.” This has bearing on why research based on transcripts of the words spoken in sessions miss what might be going on experientially and emotionally between and within patient and analyst, and how powerful this dimension of what transpires, often without words or beyond words, ultimately is.
Stavros Charalambides, Candidate TBIPS, and Athens

Sunday, October 9, 2016

Group Therapy and Supervision

I find myself in the peculiar position of supervising a candidate who is conducting group therapy. The candidate, having previously been trained in Object Relations, has a penchant for confrontation of behavior and for going straight to the unconscious. I, on the other hand, prefer a more ginger approach, trying to keep in mind the useful purposes that otherwise untoward behaviors serve to protect the self from painful affect and from fragmentation. So I find myself in a dilemma about confrontation. On the one hand I wish to discourage its use in the candidate; on the other, I find myself confronting the candidate’s behavior of using confrontation. Because the medium is the message, here I am at crossed purposes with myself.

Webster says confrontation is to fight or oppose with anger; the candidate himself said confrontation serves to put the other in a difficult position. So is this what we therapists hope for our patients, that they will find themselves in a difficult position with us? While patients do need to experience some discomfort as motivation to come to treatment, I do not think we want to purposefully generate discomfort as a therapeutic tool.  We certainly do not wish a patient to feel shamed and unable to stay in treatment. Yes, we want an opportunity to be the old object so as to bring to the table and make available for exploration past shames, but we also need to be the new object who provides a corrective emotional experience (and gives the brain the opportunity to lay down new dendritic branchings and prune old ones). It is not our job to get a patient or group member to cease a certain unwelcome behavior, but rather it is our job to help identify the purpose served by such behaviors as well as what triggered such behaviors and our part or the group’s part in that trigger. But how to convey that to a candidate in a non-shaming way?

The continuing case course’s class itself forms a group, a group participating in the peer supervision, with the instructor as facilitator or group leader. Do I then address the entire group to inquire about what happened when X said this and Y said that? Do I ask how did it feel when candidate-group leader said this or that? It is interesting how the parallel process shows itself. The group as a class forms its alliances and subgroups just as the therapeutic group, led by the candidate, does. The class, too, as the therapeutic group does, seeks understanding and a sense of responsibility for our interpersonal interactions, hopes for knowledge and a universality of experience where belonging and sameness can coexist with an appreciation of uniqueness. The tricky dual role of course instructor and group facilitator becomes more evident as the course unfolds.

Thursday, October 6, 2016

Group Therapy

Supervising a group process at TBIPS has been challenging, for now I must treat many individual members as a single whole. In part, this means that each member of the group can be viewed as if a different self-state of the whole.  The group therapist, when he or she speaks, strives to address the group process and not any one individual member of the group. Still, it is tempting to do sequential individual therapy with varying individuals, especially if the therapist is more experienced in individual therapy. Also difficult is to remember that each member’s comments can speak to what the whole group might be feeling, a feeling of which the group, and each individual in the group, may be unaware and possibly projecting onto the member who speaks what others cannot say.

For example, one member may be quite angry and her anger seems to make everyone uncomfortable. Because it is the group therapist’s job to address the group process and not any single individual, the therapist could wonder aloud how person X came to be the one to hold all the anger for the group given that everyone carries anger and also to wonder aloud how the group came to designate person X as the vessel for its anger. In this way, person X does not have to be shamed for feeling angry, nor is she told to cease behavior that makes others uncomfortable. Not directly interpreting to person X about her anger may circumvent shaming her while at the same time leaving open the possibility to the group that person X might be the courageous one or the scape-goated one, and so on. That we have in common certain feelings serves to decrease isolation and alienation, as well as to bulwark self-esteem and validation.

Interpersonal competence can be learned in a safe environment. Group therapy has the benefit of exploring multiple permutations of interpersonal relationships in the very experience near here and now as they are formed and play out amongst group members. Because transference does not only arise between a member and the therapist but between members as well, other group members are responded to as if they are parents or siblings.

The group therapist is called upon to make her or his comments addressed to the group as a whole instead of having an individual session with one member in front of all the others members. Just as individual therapy includes not only understanding (insight, cognition left brain) but also the building of a relationship between the two members of the dyad, so group therapy includes the building of a group. A sense of belonging to the group can offer the much needed ‘twinship’ experience.

Friday, September 23, 2016

Dissociation and Trauma

One of the benefits of membership in the Tampa Bay Psychoanalytic Society is participating in its monthly discussion group. This year the group is reading Philip Bromberg's Awakening the Dreamer. In the Introduction, Bromberg reprises Standing in the Spaces: "Self-states are what the mind comprises. Dissociation is what the mind does. The relationship between self-states and dissociation is what the mind is."

Bromberg sees dissociation as normative in the structure of the mind, but also as a process by which psychological survival is preserved in the face of overwhelming threat to self-continuity. When parents disallow aspects of a child's self, these aspects are dissociated by the child in order to maintain the needed tie to the parent. As the child grows into adulthood, his sense of self includes "'his parents' child'"-- that is, he continues to dissociate these aspects. Unlike repression that disavows content which causes conflict, dissociation disavows parts of the self. Bromberg claims that this disavowal of parts of the self impairs intersubjectivity such that the self is "largely unable to see himself through the eyes of an other."

Psychoanalysis, writes Bromberg, includes an act of recognition (different from understanding) of the patient's disavowed self-states, states accessible within the intersubjective field through enactment. Repeated experience with recognition [and the welcoming in] of these disavowed self-states increases their accessibility. Once accessible, these self-states are available to symbolization and self-reflection, and to conflict [the stuff addressed by traditional psychoanalysis].

In contrast, self-states that are not recognized by the analyst thwart the patient's desire for recognition and acknowledgement, and lead to shame. "..[B]ecause it is not forthcoming, [it] supports the reality of their needs being illegitimate."  But "when the therapist is able to relate to each aspect...[t]his linking of self-states increases a person's sense of wholeness..." allowing one to live a fuller life.

Saturday, September 17, 2016

In Passing

The great American playwright Edward Albee died yesterday, September 16, 2016 at the age of 88. The theatre seems to me more than any other medium to reveal the human condition pointedly and in condensed fashion. Like so many great playwrights—Miller, Williams, Chekov, of course Shakespeare – before him, these artists show us a mirror of ourselves that we sometimes wish were left unrevealed (as when Albee’s 1962 play Who’s Afraid of Virginia Woolf, which won five Tony awards, was denied the Pulitzer by the advisory board despite being voted to receive it by the jurors.)  Freud, however, would have been proud of Albee’s explications of sex, aggression, and death.

In his first play Zoo Story (1958), Albee wrote about loneliness and miscommunication. In Woolf, he exposed the illusion of the prefect American family. [What couples therapist has not seen a George and Martha in the consulting room?] The Goat, Who is Sylvia? pushed the limits of liberal tolerance when Martin falls in love with a goat (bestiality) while being somewhat judgmental of his homosexual son. Albee received the Pulitzer Prize for Drama for A Delicate Balance (1967), Seascape (1975), and Three Tall Women (1994).


On September 17, 1787 (two hundred, twenty-nine years ago today), the U.S. Constitution was adopted by the Constitutional Convention in Philadelphia, PA. One of its important compromises –between the Virginia Plan and the New Jersey Plan— allowed states to be represented both by population (The House of Representatives, favoring the larger states) and by same number of votes per state (The Senate, leveling the playing field for smaller states.)  The Constitution was ratified by conventions in eleven states and was adopted (went into effect) in 1789.  It is the longest living Constitution in the world.

The beauty of the U.S. Constitution is it is alive; It allows for changes of itself through amendments— for example, the abolition of slavery (13th), and prohibiting denial of women the right to vote (19th)—and it is interpreted to fit the lives of people in the present moment to allow for freedoms as yet unconceived by its writers and ratifiers. (Its freedoms are often hard won such as in Brown v. Board of Education of Topeka (1954) establishing separate public schools for black and white students to be unconstitutional; and Giddeons v FL (1961) allowing the accused to obtain a public defender.) Yale Law Professor and Constitutional scholar Akhil Amar said about the Constitution, “It is this epic, flawed, spectacular conversation” and “it’s the job of our generation to make it more perfect still.”

Psychoanalysis, too, is a flawed and spectacular conversation. It, too, is governed by a set of principles and procedures, and like the U.S. Constitution, is a sacred forum for struggle and negotiation where the state of the self is improved, made richer because of increased accessibility to experience and emotion, and made freer as well by being so enriched. It is through struggle and argument that our country is made better. Sometimes I think the conversation of psychoanalysis, like the voice of the vote, ought to be a basic right. But who will provide and who will pay for such a service?           

Monday, September 12, 2016

Acting Out and Passage à l'acte

On Sept 10, 2016 the Tampa Bay Psychoanalytic Society hosted Donna Bentolila at its monthly, all day seminar where she presented two riveting cases. A native of Argentina and a Lacanian by self-report, Bentolila, despite the privileging of left brain (the Symbolic) over right, and despite her reluctance to locate herself squarely in the co-creation of the experience of her patients, nonetheless, worked closely and beautifully in the lives of these two patients and their analytic relationships with her. Due perhaps to the severity of their illnesses and to complicated issues in both cases, Bentolila found herself repeatedly having to bend the frame to fit both the needs of these two very disturbed people and the limits of her capacity to endure their demands. For confidentiality sake, I will give no details, but wish you all had been there to become wholly engrossed in the presentation.

Lacan, like Freud, chose phallocentric terms to explain human experience, and I was pleased to see Bentolila try to soften Lacan’s ideas as metaphor. For example, the ‘name of the father’, Bentolila claimed, is not necessarily the biological father, but the function that transcends him. Still, this function, in addition to “constraints and proscriptions,” is to “break the fusion between mother and child." [But the idea of ‘fusion’ (or merger or symbiosis) has been reassessed since the understanding by Stern (1985) -and Benjamin- of the normal development of a sense of separateness from a very early age.]

Bentolila explained Lacan’s  distinction between acting out and passage à l'acte: Acting out is done by a subject as an attempt to communicate something to the Other which could not be heard, or said, in words. Because it remains as an attempt at communication, it thus retains the Symbolic order. Passage à l'acte (passage to [into] action), on the other hand, exits from the Symbolic Order with behavior which is not meant to communicate to the Other (the Other does not enter into consideration in the act, sometimes because there has been a dissolution of connection to the Other) for even the subject is un-situated from the scene in a desperate and irreversible attempt to resolve some unbearable anxiety (this loss of self as subject sometimes heralds psychosis), such as in the case Bentolila described.

What a wonderful reminder, as her clinical examples depicted, of how being listened to about one’s impulses makes it less likely those impulses will be acted upon. Acting out is a message to the analyst: an appeal or demand for recognition from the analyst; an attempt to communicate what the analyst had heretofore been unable to hear; an unspoken and/or unconscious invitation to dialogue about a subject that could not find a place in their discourse, perhaps because it remained dissociated (or outside the Symbolic order per Lacanians). I suppose that were the analyst to disallow space for validation, or abdicate responsibility for her own location in the fray, the patient might feel so violated and destroyed as to abandon further attempts at communication and enter instead into the real passage à l'acte.

Thursday, September 8, 2016

Comment about Homesickness and the Analytic Home

Brothers and Lewis write: “…the analyst finds ways to communicate over and over again to a patient: ‘Yes, you can come home again. No matter what happened between us during your last session, no matter how different or similar we found one another, I will be here waiting for you when it is time for us to meet again.’ "

Brothers, D., Lewis, J., (2012) Homesickness, Exile, and the Self-Psychological Language of Homecoming. International J. Psychoanalytic Self Psychol. 7:180-195.


Monday, September 5, 2016

What is Lost

The French are terribly enamored of Lacan with his symbolic and imaginary and real, and the name of the father. Lacan leans a little too heavily on Freud for my tastes and extends the patriarchal view of things, deemphasizing contributions of our understanding of the importance of the early maternal-infant relationship. Like the homunculus, a fully formed tiny human, ‘seen’ through the microscope inside the human sperm (Hartsoeker and Leeuwenhoek), thereby giving full credit to the male of the species for the preformation of the next generation, so does Lacan disregard that it is the maternal caregiver who first imparts language and law (discipline and guidance) on the infant offspring, long before any oedipal taboos.

Donna Bentolila [who will be in Tampa on Sept 10, 2016] invokes Lacan and Freud in her paper on revisiting the Death Drive (1996). Here she notes the phenomenon that desire remains ultimately unfulfilled, thus the repetition to forever chase after what we cannot have (the lost Other) as part of the human condition. [Like Freud, I think of the death drive as partially biological as in the necessity of death to make room for new life and in the second law of thermodynamics where matter tends towards the lowest energy state—making life and any biological system a kind of miracle in its randomness and its opposition to entropy. And like Winnicott, I prefer to think of destruction as a necessary dialectic allowing the Other to come into being, and a necessity in creativity.]

But it is Bentolila’s nod to difference which brings a bittersweetness to mind. Juxtaposed with sameness— a sameness which obfuscates difference— she speaks of “Eros, the union of two beings into One." She goes on to write: “For Bataille the ultimate meaning of eroticism is a state of fusion between the partners which, insofar as it involves no separation, acts to suppress all boundaries while sustaining a perfect continuity.” Later she adds “a question of an impossible jouissance with an already lost object related to our impotence to retrieve the thing (das ding) in the real.”

Ah, the lost object. To quote Robert Frost again (Reluctance, 1913):

Ah, when to the heart of man
Was it ever less than a treason
To… bow and accept the end
Of a love, or a season?

Thursday, September 1, 2016

Homesickness and Cheever

Home is the place where, when you have to go there,
                                       They have to take you in   - Robert Frost

We long for the certainty of unquestioned acceptance and welcome, a feeling of home, the place where we belong, but then come to “the realization that one’s longing for home can never be met.” Brothers and Lewis (2012) expand the idea of homesickness— in self-psychology language—as “a longing to recover (or gain for the first time) a sense of certainty that the selfobject experiences upon which selfhood depends are unquestionably available.” 

What do we do when we are confronted with the painful realization that we can never go home again, if home indeed ever was? What do we do when confronted with “this painful sense of unfulfilled and unfulfillable longing for home”? Brothers and Lewis intimate that a compensatory ‘home’ can be created by patient and analyst when they come to know one another in predictable, reliable ways and by building together a shared unique language. “In a healing analytic relationship…patient and analyst develop a shared language—partly verbal, partly nonverbal—by means of which excruciating experiences of sameness and difference become bearable.” [Here, sameness speaks to the need for twinship (see post of August 28, 2016), belonging as one does when ‘at home,’ and “the need to experience difference…to experience oneself as unique, special…”] Treatment additionally offers the opportunity for mourning what was lost, what one never had, and/or what one can never have.

Familiarity and belonging allow for the creation of meaning. But the sense of certainty and of familiarity are shattered by trauma. Trauma, in turn, can lead to exile “when trauma brings with it a desperate need to experience the clarity of difference.”

While Brothers and Lewis utilize the John Cheever quote ‘Fifty percent of people in the world are homesick all the time’ , their points about longing for what never was are also aptly illustrated in the Cheever short story Reunion (1962) where the son, meeting his father with heightened anticipation after years of estrangement, comes to the painful realization over lunch that he will never have the relationship with his father that he had always longed for; his longings for connection will remain unfulfilled; his efforts futile. Many of the works of Cheever speak to a kind of nostalgia or ‘homesickness’ for lost culture and community experienced in the isolating and alienating suburbs. There is a deep pathos in Cheever’s works. So, too, in ours.


Brothers, D., Lewis, J., (2012) Homesickness, Exile, and the Self-Psychological Language of Homecoming. International J. Psychoanalytic Self Psychol. 7:180-195.

Cheever, J., (1978) The Stories of John Cheever, New York: Alfred A. Knopf; story originally appeared in The New Yorker magazine, October 27, 1962.

Monday, August 29, 2016

Poem: Human Family by Maya Angelou

What better describes our need for sameness and difference, and for belonging, than this beautiful poem offered as an elaboration of yesterday’s post on Twinship.  

Poem: Human Family by Maya Angelou

I note the obvious differences
in the human family.
Some of us are serious,
some thrive on comedy.

Some declare their lives are lived
as true profundity,
and others claim they really live
the real reality.

The variety of our skin tones
can confuse, bemuse, delight,
brown and pink and beige and purple,
tan and blue and white.

I’ve sailed upon the seven seas
and stopped in every land,
I’ve seen the wonders of the world
not yet one common man.

I know ten thousand women
called Jane and Mary Jane,
but I’ve not seen any two
who really were the same.

Mirror twins are different
although their features jibe,
and lovers think quite different thoughts
while lying side by side.

We love and lose in China,
we weep on England's moors,
we laugh and moan in Guinea,
and thrive on Spanish shores.

We seek success in Finland,
are born and die in Maine.
In minor ways we differ,
in major ways the same.

I note the obvious differences
between each sort and type.
But we are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

We are more alike, my friends,
than we are unalike.

Sunday, August 28, 2016


Most psychoanalysts are familiar with Kohut’s mirroring and idealizing transferences. Togashi and Kottler (2012) write about the twinship transference and note Kohut’s “transformation from the psychology of the self to the psychology of being human” and from “the disorder of the self to… trauma-centered psychoanalysis.” They enumerate the many faces of twinship:

(1)    between merger and mirroring. Kohut originally conceived of the mirror transference in three forms: merger, twinship, and the narrowed mirror transference, their differences “based on the degree to which an individual” sees others as an extension of themselves or as a separate person.
(2)    as a process of mutual finding. This does not mean “recognizing…the other’s subjectivity” but rather that “two participants…regulate a sense of sameness and difference in their effort to match…their subjectivity” such as when the analyst finds aspects of herself and not-herself in her patient and the patient, likewise, can find aspects of himself and not-himself in his analyst, this mutual finding process, essential to the twinship experience.
(3)    as a sense of belonging. Later (1984), Kohut distinguished twinship from mirroring to a sense of belonging. Here twinship speaks to [authors quoting White and Weiner] ‘a similarity in interests and talents, along with the sense of being understood by someone like yourself” and [quoting Basch] ‘the need to belong and feel accepted by one’s cohort.’ [BTW, in this same volume, VanDerHyde writes a lovely paper on the importance of twinship, stating the need to belong precedes the need for mirroring or idealizing]
(4)    passing talents and skills to the next generation. Togashi and Kottler write: “For Kohut, an individual’s efforts to educate others is often based on her yearning for a person who[m] she can experience as essentially alike, or for a person in whom she can find herself.” The parent sees herself in the child and, reciprocally, the child sees himself in the parent. The child sees himself as the welcomed “successor” as the parent is “creating and finding oneself in the next generation.”
(5)    as silent communication. Twinship allows each “to share the feeling of connection without verbal communication –as with mother and infant; lovers; or analyst and patient—and to share in a “regulatory process to match (and not-match) one another.”
(6)    feeling human among other human beings. Kohut noted the necessity to feel human among other human beings. Narcissistic parents can treat the child as an extension of themselves or as a non-human thing, the latter causing the child to experience himself as non-human among non-humans.
(7)    in trauma. The authors cite Stolorow: “a need for twinship is a reaction to psychological trauma” [IMO, the authors decline to temper this statement by adding that we are hard-wired for a social network (a tribe), as well as that we can find joy in being understood and this not simply as secondary to trauma] and Brothers, noting that trauma destroys certainty and meaning. [and that we need relationship to restore the latter.]

Please see the next post for a poem by Angelou which beautifully illustrates humans’ need for a human family, same and different, but belonging.

Monday, August 22, 2016


Cultural relics have been targeted by ISIS in northern Africa and the Middle East in alarming numbers. The first successful prosecution by the International Criminal Court for only the destruction of cultural heritage took place today at The Hague. Ahmad Al-Fagi Al-Mahdi took part in the destruction by Islamic militants of the 14th century Holy Tombs of Timbuktu in his native Mali in 2012 and today he admitted and apologized, calling for an end to these acts.

The phrase destruction of cultural heritage got me thinking about our individual specific and pointed cultural heritage, that of each of our families, and how psychoanalysts navigate the change in perspective of our unique stories. Some people come to us hoping we will undo what they have had to endure, or hoping that the painful experiences of childhood will be eradicated. But our history is part of who we are, for better or worse, forever embedded in our neuro-circuitry [unless damage occurs, such as by a stroke or traumatic brain injury] and I encourage patients to respect what has transpired, give it its due, its voice, and give it a place beside all that has made them the courageous and resourceful enough person now before me who seeks psychotherapeutic treatment.

Some patients worry, as we empathize with the relational trauma of chronic misrecognition and misattunement or with the Trauma of physical and sexual abuse of their childhoods, that their newly welcomed and understandable anger will be insurmountable to finding their way back to loving and forgiving their families of origin. It does seem remarkable that, if we persevere with recognizing, naming, and accepting anger, we will find it can be more easily lived, lived alongside the more palatable emotions and memories that are human experience.  I don’t know how forgiveness for heinous acts comes about, but it seems partially linked to learning to forgive ourselves. I know I am grateful life-long for those who have forgiven me.

Friday, August 19, 2016

"the pleasures and perils" of technology

Tonight on the PBS NewsHour was aired an interview with German filmmaker Werner Herzog (Grizzly Man; The Cave of Forgotten Dreams) whose latest film, the documentary Lo and Behold: Reveries of the Connected World was released today. He asks “What makes us human? How do we communicate?” Herzog, like myself, does not have a cell phone as a matter of culture. Like me, he wants to be involved with the person across the table with whom he shares a meal and not be available to everyone else all the time.

It is a danger if we teach our children, for example: when preoccupied with our cell phones, that they are uninteresting and unimportant. A parent, chronically disinterested in the experiences of a child, may seriously impede the development of that child’s ‘voice.’ Many years ago, when my younger daughter was in preschool, I observed a sad scene.

Another parent and I drove into the parking lot at the same time. She was on her cell phone. We parked alongside one another. We walked the sidewalk together, into the building together, down the hall, and out the door to the playground area. She was still on her cell phone. I dropped to my knees when I saw my daughter and opened my arms. My daughter ran into them. The other parent did not say ‘hi’ to the little boy she had come for, but took his hand and the four of us retraced our steps. My daughter is telling me of her morning experiences as I buckle her into her car seat. The woman next to me is still on her phone. Her son is silent.

What or who is it that is so compelling on the other end of a cell phone that is worth making the person right beside us feel second best?

One of the salubrious pleasures of the quiet consulting room is the intense attention paid to one another as we struggle to navigate intimacy in the here and now.